Older men and women differ in their end-of-life experiences. While increasing attention has been focused on gender differences in health status, prevalence of illnesses, and accesses to quality care among older adults, little is known about differences in their health care in the last years of their lives. This study proposes to improve our understanding of this issue by analyzing a five-year sample of Medicare claims data to assess gender differences among Medicare-eligible adults with lung or colorectal cancer in their utilization of health care services in the last year of life. With the permission of the Medicare Payment Advisory Commission (MedPAC), we can maintain our current access to a 5% sample of Medicare claims data for 1994 to 1999. This continued access will increase the efficiency of data handling and reduce costs substantially. Without access to this data through MedPAC, it would take approximately one year to obtain the appropriate files at a significant cost. The nationally representative sample includes a large cohort of African Americans and nearly comprehensive data on medical services utilization and cost. This retrospective cohort study will set the stage for a prospective study of men's and women's end-of-life care. We propose to address the following research questions: 1)describe and analyzed age and gender differences in costs and patterns of end-of life care for Medicare beneficiaries with lung and colorectal cancer; 2) describe gender differences in end-of-life care for those with cancer, including stays in a hospital or a skilled nursing facility in the last year of life; use of hospice, home care, or physician's services; and site of death (home, hospital, or nursing facility); and 3) determine whether gender differences in health services utilization and expenditures for cancer patients vary by race and community characteristics such as availability of hospital beds and physician providers.